Catheter-related thrombosis in a neonatal intensive care unit: a case-control study / Trombose relacionada a cateter em unidade de terapia intensiva neonatal: um estudo de caso-controle

INTRODUCTION: Catheter-related thrombosis (CRT) accounts for most thrombotic events in the neonate. OBJECTIVE: Investigate CRT frequency, association with days of catheter use until diagnosis, and number of catheters used, in a single-center Neonatal Intensive Care Unit. METHODS: A case-control study that included 14 cases and 42 controls. Data collection occurred between January 2017 and December 2020 in a public NICU. Crude odds ratios (COR) were calculated. The study complied with ethical standards from national guidelines. RESULTS: Two hundred and ninety-four neonates used central venous catheters, of which 14 (4.7%) were diagnosed with CRT. Catheter in use when diagnosis was made was centrally inserted central catheters in 8 (57.1%). Before diagnosis, the cumulative duration of catheter use was 34.5 days and the median number of catheters used was three. A higher SNAPPE-II (COR 1.03; 95% CI 1.01-1.06; p=0.03), cumulative days of catheter use >30 (COR 19.11; 95% CI 2.28-160.10; p=0.007) and number of catheters used ≥3 (COR 7.66; 95% CI 1.51-38.70; p=0.01) were associated with CRT. CONCLUSION: CRT cases were associated with clinical severity; number of catheters and cumulative days of catheter use. We suggest that screening for thrombosis should be performed in neonates who need a long time of catheter use and more than three catheters. Reducing the duration and number of venous catheters used will help to reduce CRT.

INTRODUÇÃO: A trombose relacionada ao cateter (TRC) é responsável pela maioria dos eventos trombóticos no neonato. OBJETIVO: Investigar a frequência da TRC, a associação com os dias de uso do cateter até o diagnóstico e o número de cateteres utilizados em uma Unidade de Terapia Intensiva Neonatal unicêntrico. MÉTODOS: Estudo caso-controle que incluiu 14 casos e 42 controles. A coleta de dados ocorreu entre janeiro de 2017 e dezembro de 2020 em uma UTIN pública. Foram calculadas razões de chances brutas (COR). O estudo respeitou os padrões éticos das diretrizes nacionais. RESULTADOS: Duzentos e noventa e quatro neonatos utilizaram cateter venoso central, dos quais 14 (4,7%) foram diagnosticados com TRC. O cateter em uso no momento do diagnóstico foi o cateter central inserido centralmente em 8 (57,1%). Antes do diagnóstico, o tempo acumulado de uso do cateter foi de 34,5 dias e a mediana do número de cateteres utilizados foi de três. Um maior número de dias de uso do cateter >30 (COR 19,11; IC 95% 2,28-160,10; p=0,007) e número de cateteres utilizados >3 (COR 7,66; IC 95% 1,51-38,70; p=0,01). CONCLUSÃO: Os casos de TRC foram associados à gravidade clínica; número de cateteres e dias cumulativos de uso do cateter. Sugerimos que o rastreamento de trombose seja realizado em neonatos que necessitem de longo tempo de uso do cateter e mais de três cateteres. Reduzir a duração e o número de cateteres venosos usados ajudará a reduzir a TRC.

Factores asociados con la infección por el virus de la hepatitis B en comunidades indígenas de Colombia / Factors associated with hepatitis B virus infection in indigenous communities of Colombia

Introducción. Colombia alberga dos millones de indígenas, que viven en condiciones de pobreza y tienen deficiencias en salud, por lo cual están expuestos a contraer infecciones virales como la hepatitis B. El departamento del Amazonas presenta una gran prevalencia del virus y barreras para acceder a la vacunación; por esto, parte de la población es propensa a la infección. Objetivo. Identificar factores asociados con la infección por el virus de la hepatitis B en indígenas colombianos. Materiales y métodos. Se llevó a cabo un estudio de casos y controles en mayores de 18 años de cuatro departamentos del país. Los casos se identificaron mediante el registro nacional de notificación de hepatitis B (2015-2022). Los controles seleccionados de manera concurrente fueron pareados con los casos por edad, sexo, etnia y departamento. En una encuesta se consignaron las características sociodemográficas, los factores asociados con el contacto con sangre y fluidos, las prácticas socioculturales y los antecedentes de vacunación. El proyecto fue aprobado por Comité de Ética de la Universidad de Antioquia. Resultados. Participaron 75 casos y 150 controles de 13 grupos étnicos. El departamento del Amazonas aportó el 49 % de los participantes (83 % mujeres) con una mediana de edad de 30 años (RIC = 27-37). Los factores asociados con una mayor probabilidad de contraer la infección fueron el antecedente de algún familiar infectado con el virus de la hepatitis B (OR ajustado = 2,61) (IC95%: 1,09-6,27) y número de embarazos en mujeres, (OR ajustado = 1,61) (IC95%: 1,02-2,54). La vacunación mostró un efecto protector sin asociación significativa. Conclusión. Los aspectos asociados con la convivencia familiar y el número de embarazos contribuyen a una potencial transmisión vertical y horizontal del virus. No se identificaron prácticas culturales asociadas. Se requieren estrategias novedosas y diferenciales para reducir la transmisión del virus de la hepatitis B en poblaciones indígenas.

Introduction. Colombia is home to 2 million indigenous people who live in conditions of poverty and with health deficiencies, making them vulnerable to contracting hepatitis B (HBV). Amazonas has a high virus prevalence, and there are barriers to accessing vaccination; thus, part of the population is susceptible to infection. Objective. To identify factors associated with HBV in Colombian indigenous people. Materials and Methods. A case-control study of people over 18 years from four departments of Colombia. Cases were identified through the national hepatitis B notification registry (2015-2022). Controls were selected and matched to cases (2:1) by age, sex, ethnicity, and department. Sociodemographic characteristics, factors associated with contact with body fluids, cultural practices, and vaccination history were identified by means of a survey. The ethics committee of the Universidad de Antioquia approved the project. Results. Seventy five cases and 150 controls from 13 ethnic groups were surveyed. Amazonas contributed 49% of participants, 83% were women, and the median age of cases was 30 years (IQ range: 27-37). The associated factors were a family history of hepatitis B [adjusted OR: 2.61 (95% CI: 1.09-6.27)] and, in women, the number of pregnancies [adjusted OR: 1.61 (95% CI 1.02- 2.54)]. The vaccination history showed a protective effect, but the association was not significant. Conclusion. Aspects associated with family life and unprotected sexual relations seem to be responsible for the potential transmission of the virus. It was not possible to identify associated cultural practices. Innovative and differential strategies are required for indigenous people to achieve a reduction of HBV.

How to conduct and write a case-control study

@#<p style="text-align: justify;" data-mce-style="text-align: justify;">A case control study is a type of observational study. In this study design, participants are selected to participate depending on their outcome status. Cases are participants with outcome of interest whereas controls are participants who do not have the outcome of interest. These studies estimate the odds ratio or the odds between the exposure and health outcome, however they cannot prove causality. Advantages of case control studies include the following: inexpensive, easy to design and implement, and are used to study rare outcomes. Case control studies are prone to certain research bias but can be addressed by the investigator through careful designing and planning. This paper describes the case control studies, their advantages, bias in case control studies and how to address them, and discuss the steps in how to conduct this type of study design.</p>

Study on transcriptome characteristics of respiratory syncytial virus bronchiolitis in children by RNA sequencing / 中华预防医学杂志

To explore the biological characteristics related to the pathogenesis and severity of respiratory syncytial virus (RSV) bronchiolitis by RNA sequencing of white blood cells in children with RSV bronchiolitis. This study is a case-control study. A total of 87 children diagnosed with bronchiolitis and RSV antigen positive and/or RSV nucleic acid positive in the pediatric respiratory department of the Second Affiliated Hospital of Wenzhou Medical University from October 2019 to April 2022 were selected as the case group. The case group was divided into three groups based on the condition: mild, moderate, and severe, and there were two groups according to the presence or absence of atopic symptoms: the atopic group and the non-atopic group, forty healthy children in the same period were selected as the control group. The whole blood leukocyte RNA of the children in the case group and the control group was extracted for RNA sequencing, and the data were analyzed to obtain differentially expressed genes (DEGs). Then, the immunobiological pathways and genes related to the pathogenesis, disease condition, and atopy were screened through Gene Ontology (GO) annotation, Kyoto Gene and Genome Encyclopedia (KEGG) annotation, and protein interaction network (PPI) construction methods. Construct the weighted gene co-expression network analysis (WGCNA) module to identify potential biological indicators related to disease severity.Compared with the control group, the case group had a total of 1 782 DEGs, including 1 586 upregulated genes and 196 downregulated genes. The GO pathway enrichment of DEGs is mainly enriched in molecular functions such as peroxidase activity and oxidoreductase activity. In the cytological components, it is mainly enriched in cytoplasmic vesicle lumen and secretory granule lumen. In biological processes, it is mainly enriched in processes such as neutrophil activation involved in immune responses, neutrophil degranulation, and neutrophil activation. KEGG analysis is mainly concentrated in the signal pathway of the viral protein interaction with cytokine and cytokine receptor. A PPI network was constructed to screen four genes at the core position, including CCL2, IL-10, MMP9 and JUN. The DEGs obtained by comparing different disease groups with the control group are mainly enriched in retrograde endocannabinoid signaling and cell apoptosis pathways. WGCNA analysis showed that the brown module related to oxygen saturation was most closely related to the disease, and its gene was mainly enriched in the RNA helicase retinoic acid inducible gene-I (RIG-I) like receptor signal pathway. There are 230 specific DEGs in the atopic group and 444 in the non-atopic group. KEGG enrichment analysis results show that both groups are enriched to NF-κB signaling pathway, the characteristic does not cause significant changes in immune response and transcriptome characteristics in children with RSV bronchiolitis. In conclusion, neutrophil activation, degranulation pathway and signal pathway of interaction between viral protein and cytokine and cytokine receptor are involved in the immune response of RSV bronchiolitis host. CCL2, IL-10, MMP9 and JUN genes may be associated with the pathogenesis. They might be potential biomarkers related to disease severity in RIG-I like receptors, cell apoptosis, and endogenous cannabinoid related signaling pathways.

Study on transcriptome characteristics of respiratory syncytial virus bronchiolitis in children by RNA sequencing / 中华预防医学杂志

To explore the biological characteristics related to the pathogenesis and severity of respiratory syncytial virus (RSV) bronchiolitis by RNA sequencing of white blood cells in children with RSV bronchiolitis. This study is a case-control study. A total of 87 children diagnosed with bronchiolitis and RSV antigen positive and/or RSV nucleic acid positive in the pediatric respiratory department of the Second Affiliated Hospital of Wenzhou Medical University from October 2019 to April 2022 were selected as the case group. The case group was divided into three groups based on the condition: mild, moderate, and severe, and there were two groups according to the presence or absence of atopic symptoms: the atopic group and the non-atopic group, forty healthy children in the same period were selected as the control group. The whole blood leukocyte RNA of the children in the case group and the control group was extracted for RNA sequencing, and the data were analyzed to obtain differentially expressed genes (DEGs). Then, the immunobiological pathways and genes related to the pathogenesis, disease condition, and atopy were screened through Gene Ontology (GO) annotation, Kyoto Gene and Genome Encyclopedia (KEGG) annotation, and protein interaction network (PPI) construction methods. Construct the weighted gene co-expression network analysis (WGCNA) module to identify potential biological indicators related to disease severity.Compared with the control group, the case group had a total of 1 782 DEGs, including 1 586 upregulated genes and 196 downregulated genes. The GO pathway enrichment of DEGs is mainly enriched in molecular functions such as peroxidase activity and oxidoreductase activity. In the cytological components, it is mainly enriched in cytoplasmic vesicle lumen and secretory granule lumen. In biological processes, it is mainly enriched in processes such as neutrophil activation involved in immune responses, neutrophil degranulation, and neutrophil activation. KEGG analysis is mainly concentrated in the signal pathway of the viral protein interaction with cytokine and cytokine receptor. A PPI network was constructed to screen four genes at the core position, including CCL2, IL-10, MMP9 and JUN. The DEGs obtained by comparing different disease groups with the control group are mainly enriched in retrograde endocannabinoid signaling and cell apoptosis pathways. WGCNA analysis showed that the brown module related to oxygen saturation was most closely related to the disease, and its gene was mainly enriched in the RNA helicase retinoic acid inducible gene-I (RIG-I) like receptor signal pathway. There are 230 specific DEGs in the atopic group and 444 in the non-atopic group. KEGG enrichment analysis results show that both groups are enriched to NF-κB signaling pathway, the characteristic does not cause significant changes in immune response and transcriptome characteristics in children with RSV bronchiolitis. In conclusion, neutrophil activation, degranulation pathway and signal pathway of interaction between viral protein and cytokine and cytokine receptor are involved in the immune response of RSV bronchiolitis host. CCL2, IL-10, MMP9 and JUN genes may be associated with the pathogenesis. They might be potential biomarkers related to disease severity in RIG-I like receptors, cell apoptosis, and endogenous cannabinoid related signaling pathways.

Association of vitamin D receptor gene polymorphisms with type 2 diabetes mellitus in Taif population: a case-control study / Associação de polimorfismos do gene do receptor de vitamina D com diabetes mellitus tipo 2 na população Taif: um estudo de caso-controle

Abstract Several reasons may underlie the dramatic increase in type2 diabetes mellitus. One of these reasons is the genetic basis and variations. Vitamin D receptor polymorphisms are associated with different diseases such as rheumatoid arthritis and diabetes. The aim of this study is to investigate the possible association of two identified mutations ApaI (rs7975232) and TaqI (rs731236). Eighty-nine healthy individuals and Fifty-six Type 2 Diabetic (T2D) patients were investigated using RFLP technique for genotyping and haplotyping as well. The distribution of Apal genotypes was not statistically significant among the control (P=0.65) as well as for diabetic patients (P=0.58). For Taql allele frequencies of T allele was 0.61 where of G allele was 0.39. The frequency distribution of Taql genotypes was not statistically significant among the control (P=0.26) as well as diabetic patients (P=0.17). Relative risk of the allele T of Apa1 gene is 1.28 and the odds ratio of the same allele is 1.53, while both estimates were < 1.0 of the allele G. Similarly, with the Taq1 gene the relative risk and the odds ratio values for the allele T are 1.09 and 1.27 respectively and both estimates of the allele C were 0.86 for the relative risk and 0.79 for the odds ratio. The pairwise linkage disequilibrium between the two SNPs Taq1/apa1 was statistically significant in control group (D = 0.218, D' = 0.925 and P value < 0.001) and similar data in diabetic groups (D = 0.2, D' = 0.875 and P value < 0.001). These data suggest that the T allele of both genes Apa1 and Taq1 is associated with the increased risk of type 2 diabetes. We think that we need a larger number of volunteers to reach a more accurate conclusion.

Resumo Várias razões podem estar subjacentes ao aumento dramático da diabetes mellitus tipo 2. Um desses motivos é a base genética e variações. Os polimorfismos do receptor da vitamina D estão associados a diferentes doenças, como artrite reumatoide e diabetes. O objetivo deste estudo é investigar a possível associação de duas mutações identificadas ApaI (rs7975232) e TaqI (rs731236). Oitenta e nove indivíduos saudáveis ​​e 56 pacientes com diabetes tipo 2 (T2D) foram investigados usando a técnica RFLP para genotipagem e haplotipagem também. A distribuição dos genótipos Apal não foi estatisticamente significativa entre o controle (P = 0,65), bem como para os pacientes diabéticos (P = 0,58). Para as frequências do alelo Taql, o alelo T foi de 0,61, onde o alelo G foi de 0,39. A distribuição de frequência dos genótipos Taql não foi estatisticamente significativa entre o controle (P = 0,26), bem como os pacientes diabéticos (P = 0,17). O risco relativo do alelo T do gene Apa1 é 1,28 e a razão de chances do mesmo alelo é 1,53, enquanto ambas as estimativas foram < 1,0 do alelo G. Da mesma forma, com o gene Taq1, os valores de risco relativo e razão de chances para o alelo T são 1,09 e 1,27, respectivamente, e ambas as estimativas do alelo C foram de 0,86 para o risco relativo e 0,79 para o odds ratio. O desequilíbrio de ligação par a par entre os dois SNPs Taq1 / apa1 foi estatisticamente significativo no grupo de controle (D = 0,218, D' = 0,925 e valor P < 0,001) e dados semelhantes em grupos diabéticos (D = 0,2, D' = 0,875 e valor P < 0,001). Esses dados sugerem que o alelo T de ambos os genes Apa1 e Taq1 está associado ao aumento do risco de diabetes tipo 2. Achamos que precisamos de um número maior de voluntários para chegar a uma conclusão mais precisa.

Biological, social, and healthcare factors for death due to influenza A(H1N1) during the 2009 epidemic in Brazil

ABSTRACT OBJECTIVE To identify risk factors for death from influenza A(H1N1), including the effectiveness of the vaccine against influenza A(H1N1) concerning mortality. METHODS A case-control of incident cases of influenza A(H1N1) reported in the epidemiological information systems of the states of São Paulo, Paraná, Pará, Amazonas, and Rio Grande do Sul was conducted. RESULTS 305 participants were included, 70 of them cases and 235 controls, distributed as follows: Amazonas, 9 cases/10 controls; Pará, 22 cases/77 controls, São Paulo, 19 cases/49 controls; Paraná, 10 cases/54 controls; Rio Grande do Sul, 10 cases/45 controls. These participants had a mean age of 30 years, with 33 years among cases and 25 years among controls. There was a predominance of females both among the cases and controls. Biological (age), pre-existing diseases (congestive heart failure, respiratory disease, and diabetes mellitus), and care factors (ICU admission) associated with death from influenza A(H1N1) were identified. CONCLUSION The risk factors identified in this investigation not only allowed subsidizing the elaboration of clinical conducts but also indicate important aspects for facing "new" influenza epidemics that are likely to occur in our country.

Cesárea por requerimiento materno y sus posibles determinantes: estudio de casos y controles en Centro Hospitalario Pereira Rossell / Cesarean delivery on maternal request and its possible determinants: a case-control study at Centro Hospitalario Pereira Rossell / Cesárea por solicitação materna e seus possíveis determinantes: estudo de casos e controles no Centro Hospitalar Pereira Rossell

Introducción: La cesárea por solicitud materna, aquella sin indicación médica materna ni fetal, ha aumentado en los últimos años. Se han descrito motivos para que la paciente solicite la misma, como experiencias emocionales, normas sociales, y la interrelación con el equipo de salud. Metodología: El objetivo fue determinar posibles determinantes para la solicitud de cesárea. Se realizó un estudio observacional de casos (pacientes que solicitaron cesárea sin indicación médica) y controles (parto vaginal espontáneo), no pareados, en una relación 2:1. Se utilizó una encuesta prediseñada para determinar los posibles determinantes, incluyendo el miedo al parto mediante cuestionario adaptado de W-DEQ, soporte social, preocupación por la seguridad fetoneonatal y la influencia del médico tratante. Resultados: Se incluyeron 171 pacientes. Dentro de las pacientes con cesárea por requerimiento materno, el 52,5% manifestó la elección de cesárea por preocupación por la alta seguridad fetoneonatal, el 32,8% por alguna influencia del médico tratante, el 31,7 % por su predictibilidad (mejor organización del hogar o por la angustia de la falta de certeza del momento del parto) y el 42,6% por preocupación personal por las consecuencias debidas al parto vaginal. La variable WDEQ, categorizada en terciles, mostró una asociación para solicitar cesárea con significancia estadística. La historia traumática previa mostró una asociación de 4,17. Conclusiones: Los factores que influyeron en la decisión de solicitar una cesárea fueron la historia traumática previa, la influencia del médico tratante y la existencia de tocofobia. Lo que une a todos estos factores es que son todos modificables.

Introduction: Cesarean delivery on maternal request, which occurs without maternal or fetal medical indication, has increased in recent years. Reasons for patients to request it have been described, such as emotional experiences, social norms, and the interrelationship with the healthcare team. Methodology: The objective was to determine possible determinants for cesarean request. An observational study was conducted with cases (patients who requested cesarean delivery without medical indication) and controls (spontaneous vaginal delivery), non-matched, in a 2:1 ratio. A pre-designed survey was used to determine possible determinants, including fear of childbirth through a W-DEQ adapted questionnaire, social support, concern for fetal-neonatal safety, and the influence of the treating physician. Results: A total of 171 patients were included. Among patients with cesarean delivery on maternal request, 52.5% reported choosing cesarean due to high concern for fetal-neonatal safety, 32.8% due to some influence from the treating physician, 31.7% due to its predictability (better home organization or the anxiety of uncertainty about the timing of delivery), and 42.6% due to personal concern about the consequences of vaginal delivery. The W-DEQ variable, categorized into tertiles, showed a statistically significant association for requesting cesarean delivery. Previous traumatic history showed an association of 4.17. Conclusions: The factors that influenced the decision to request a cesarean delivery were previous traumatic history, the influence of the treating physician, and the existence of tocophobia. What connects all these factors is that they are all modifiable.

Introdução: A cesárea por solicitação materna, aquela realizada sem indicação médica materna ou fetal, aumentou nos últimos anos. Motivos para que a paciente solicite a mesma foram descritos, como experiências emocionais, normas sociais e a inter-relação com a equipe de saúde. Metodologia: O objetivo foi determinar possíveis determinantes para a solicitação de cesárea. Foi realizado um estudo observacional de casos (pacientes que solicitaram cesárea sem indicação médica) e controles (parto vaginal espontâneo), não pareados, em uma relação 2:1. Utilizou-se uma pesquisa pré-desenhada para determinar os possíveis determinantes, incluindo o medo do parto por meio de um questionário adaptado do W-DEQ, suporte social, preocupação com a segurança fetoneonatal e a influência do médico responsável. Resultados: Foram incluídas 171 pacientes. Entre as pacientes com cesárea por requerimento materno, 52,5% manifestaram escolher a cesárea por preocupação com a alta segurança fetoneonatal, 32,8% por alguma influência do médico responsável, 31,7% por sua previsibilidade (melhor organização do lar ou pela angústia da falta de certeza sobre o momento do parto) e 42,6% por preocupação pessoal com as consequências do parto vaginal. A variável W-DEQ, categorizada em tercis, mostrou uma associação para solicitar cesárea com significância estatística. A história traumática anterior mostrou uma associação de 4,17. Conclusões: Os fatores que influenciaram a decisão de solicitar uma cesárea foram a história traumática anterior, a influência do médico responsável e a existência de tocofobia. O que une todos esses fatores é que todos são modificáveis.

Parámetros ventilatorios asociados a mortalidad en pacientes con neumonía adquirida en la comunidad grave / Ventilatory Parameters Associated to Mortality in Patients with Severe Community-Acquired Pneumonia

Introducción: La predicción del desenlace de los pacientes tratados con ventilación invasiva por insuficiencia respiratoria aguda es todo un reto. Objetivo: Analizar los parámetros de monitorización ventilatoria asociados a la mortalidad en pacientes con neumonía adquirida en la comunidad grave. Métodos: Se realizó un estudio de casos y controles en pacientes con neumonía adquirida en la comunidad grave, tratados con ventilación invasiva. Los casos fueron los pacientes fallecidos. Las variables cuantitativas se resumieron con la mediana y el rango intercuartil en la comparación entre casos y controles, se empleó la prueba de U de Mann - Whitney. Se computó la presencia de riesgo de mortalidad y su significación estadística mediante el análisis de los odds ratio (OR), sus intervalos de confianza y la prueba ji al cuadrado de Mantel y Haenszel con nivel de significación ɑ = 0,05. Resultados: Los pacientes con las siguientes variables: presión pico ≥ 32 cmH2O (OR = 9,27), presión meseta ≥ 24 cmH2O (OR = 24,10), presión media ≥ 19 cmH2O (OR = 10,21), presión de conducción ≥ 19 cmH2O (OR = 10,98), compliance estática < 20 ml/cmH2O (OR = 5,90) y compliance dinámica < 15 ml/cmH2O (OR = 14,20), tuvieron más probabilidad de fallecer. Conclusiones: Los parámetros de la presión pico, la presión meseta, la presión media, la presión de conducción, la compliance estática y la compliance dinámica están asociados a la mortalidad en pacientes con neumonía adquirida en la comunidad grave.

Introduction: Predicting the outcome in patients treated with invasive ventilation for acute respiratory failure is fully challenging. Objective: To analyze ventilatory monitoring parameters associated with mortality in patients with severe community-acquired pneumonia. Methods: A case-control study was carried out in severely-ill patients with community-acquired pneumonia and treated with invasive ventilation. The cases were the deceased patients. The quantitative variables were summarized using the median and the interquartile range, while the Mann-Whitney U test was used in the comparison between cases and controls. The presence of mortality risk and its statistical significance were computed by odds ratio (OR) analysis, their confidence intervals, as well as the Mantel and Haenszel chi-squared test, with significance level ɑ = 0.05. Results: The patients more likely to die were those with peak pressure ≥ 32 cmH2O (OR = 9.27), plateau pressure ≥ 24 cmH2O (OR = 24.10), mean pressure ≥ 19 cmH2O (OR = 10.21), driving pressure ≥ 19 cmH2O (OR = 10.98), static compliance < 20 ml/cmH2O (OR = 5.90) and dynamic compliance < 15 ml/cmH2O (OR = 14.20). Conclusions: The variables peak pressure, plateau pressure, mean pressure, driving pressure, static compliance and dynamic compliance were concluded to be associated with mortality in patients with severe community-acquired pneumonia.

Caracterización metabólica y frecuencia del polimorfismo I/D (rs4646994) del gen ACE1 en adultos con diagnóstico de diabetes de nueva aparición posterior a COVID-19 / Metabolic characterization and frequency of ACE1 gene I/D (rs4646994) polymorphism in adults diagnosed with new-onset diabetes after COVID-19

Evidencia reciente ha demostrado que el virus SARS-CoV-2 causante de la enfermedad COVID-19 puede producir daño directo al páncreas sugiriendo un posible efecto diabetógeno. El objetivo de este estudio de caso-control fue evaluar el perfil metabólico y determinar la frecuencia del alelo de riesgo del gen de la enzima convertidora de angiotensina (ACE1), en adultos con diabetes mellitus (DM) de nueva aparición post COVID-19. Se reclutaron 41 participantes (16 casos y 25 controles) de ambos sexos. Los casos fueron sujetos con DM de nueva aparición post COVID-19, de acuerdo con los criterios de la Asociación Americana de Diabetes (ADA). Los controles fueron sujetos con diagnóstico de COVID-19 pero sin DM. Se evaluó el estado nutricional, metabólico y la presencia del polimorfismo I/D del gen ACE1 en muestras de ADN genómico. Se encontró que el perfil metabólico de ambos grupos es similar, con un incremento significativo en los niveles de glicemia, hemoglobina glicosilada (Hb1Ac) y calcio sérico. No se encontraron diferencias en la detección del autoanticuerpo Anti-GAD65 y la frecuencia del polimorfismo I/D del gen de ACE1 no se encontró asociada a los casos de DM post COVID-19 en esta población. El estudio encontró que este polimorfismo no está asociado con la diabetes de nueva aparición post COVID-19, a pesar de las alteraciones metabólicas significativas observadas en los pacientes.

The SARS-CoV-2 virus causes COVID-19 disease. Evidence suggests that it can directly harm the pancreas, indicating a potential to cause diabetes. This study aimed to assess the metabolic profile and determine the frequency of the risk allele of the angiotensin-converting enzyme (ACE) gene in adults who developed new-onset diabetes mellitus (DM) after contracting COVID-19, compared to control subjects. Our study involved forty-one participants, including 16 cases and 25 controls of both sexes. The cases were individuals who developed new-onset diabetes after COVID-19, as per the American Diabetes Association (ADA) criteria, while the controls were individuals diagnosed with COVID-19 but without diabetes. We evaluated the nutritional and metabolic status of the participants, as well as the ACE1 gene I/D polymorphism in their genomic DNA samples, using a significance level of p<0.05 for statistical analyses. The metabolic profiles of both groups were similar, showing a significant increase in glycemia levels, glycosylated hemoglobin (Hb1Ac), and serum calcium. No differences were found in detecting Anti-GAD65 autoantibodies, and the ACE1 gene I/D polymorphism frequency was not associated with new-onset diabetes post-COVID-19 in this population. In conclusion, our study found that the ACE1 gene I/D polymorphism is not associated with new-onset diabetes post-COVID-19, despite the significant metabolic alterations observed in patients.

Mid-pregnancy circulating cytokine levels, placental efficiency and their relationship with preterm birth

Abstract Objective To assess a panel of cytokines and placental insufficiency with the risk of preterm delivery (PTD). Methods Nested case-control study into the BRISA birth cohort. Eighty-two mother-infant-placenta pairs were selected at 20+0 to 25+6 weeks. Circulating biomarker levels were performed using Luminex flowmetric xMAP technology. Cytokines classified as Th1, Th2 or Th17 and other biomarkers were selected. The ratio between birth weight and placental weight (BW/PW) was used as a proxy for placental efficiency. Spearman correlation, univariate analyses and logistic regression models were calculated. Sensitivity, specificity, positive and negative likelihood ratios were calculated using the Receiver Operating Characteristic curve. Results Mean gestational age was 250 days, 14,6% were small for gestational age, 4,8% large for gestational age and 13,4% stunted. Placental efficiency was higher for term newborns (p<0,001), and 18/22 (81%) preterm biomarker values were higher than the control group. Th1 cytokines were highly correlated, while the weakest correlation was observed in other biomarkers. Less education was associated with a higher risk of PTD (p = 0.046), while there was no appreciable difference in the risk of PTD for placental insufficiency. Biomarkers showed negligible adjusted OR of PTD (0.90 to 1.02). IL-6, IL-8, IL-1β, TNFβ, IL-4, IL-13, GCSF, MIP1A, VEGF, EGF, and FGF2 presented a higher sensitivity ranging from 75.56% to 91.11%. Conclusion IL-8, IL-12p40, IL-4, IL-13, GCSF, MIP1B, and GMSF in asymptomatic pregnant women were associated with PTD. This finding suggests an activation of maternal inflammatory response.

Estudo do microbioma intestinal de pacientes com doença psoríasica grave / Study of the intestinal microbiome of patients with severe psoriatic disease

Introdução: A disbiose intestinal parece desempenhar um papel importante em diversas doenças imunomediadas, havendo um interesse crescente em compreender a influência do microbioma intestinal na doença psoriásica. Objetivos: Estudar o microbioma intestinal em pacientes com doença psoriásica grave em comparação com indivíduos sem psoríase. Em paralelo, avaliar as diferenças do microbioma intestinal de indivíduos portadores de psoríase, com e sem doença articular associada. Por fim, avaliar o microbioma dos indivíduos do grupo controle, diferenciando-os quanto a história positiva de psoríase em parentes de primeiro grau. Métodos: Estudo tipo caso controle, onde foi realizado sequenciamento do gene 16S rRNA V3/V4 e análises bioinformáticas com o DNA total extraído de amostras de fezes de 30 pacientes com doença psoriásica grave e 30 controles, pareados por idade e sexo e pertencentes à mesma localização geográfica. A classificação de gravidade respeitou os critérios do consenso, sendo considerados graves aqueles com superfície corporal acometida acima de 10% e/ou escore de PASI maior que 10 e/ou questionário DLQI maior que 10.Resultados: Foram estudados 60 indivíduos. Não se documentou diferença em alfa diversidade entre os grupos (p > 0.05). Entretanto, a análise da diversidade beta do microbioma intestinal mostrou diferentes agrupamentos entre os pacientes portadores de psoríase quando comparados aos controles (p = 0.031). A relação Firmicutes/Bacteriodetes (F/B) foi maior nos expostos (p = 0.05). A abundância diferencial ajustada mostrou aumento da expressão do gênero Sutterella (p < 0.01) e da espécie Sutterella wadsworthensis (p < 0.05) no grupo com psoríase. Quando comparados pacientes com e sem doença articular, não foi possível documentar diferenças em termos de alfa ou betadiversidade. Entretanto, pacientes com artrite psoriásica estabelecida apresentaram maior expressão do gênero Bacterioides (p = 0.02), além da espécie Bacteriodes uniformes (p = 0.03). Não foi identificada qualquer diferença relevante entre os controles, quando comparados indivíduos com e sem história familiar de psoríase. Conclusões: Foi possível demonstrar um microbioma intestinal diferente entre os portadores de doença psoriásica grave, quando comparados aos controles sem psoríase. Verificou-se uma maior expressão, significativa, do gênero Sutterella e da espécie Sutterella wadsworthensis entre os portadores de doença psoriásica, podendo representar uma marca da disbiose relacionada à esta doença. Em paralelo, verificouse diferenças estatísticamente siginificativas entre pacientes com doença articular, sendo, porém, uma marca nestes pacientes a maior expressão do gênero Bacterioides e da espécie Bacteriodes uniformes. Cabe destacar que a razão F/B foi inferior nos expostos. Achado não inédito, porém contrário a maior parte das publicações onde se demonstra predomínio do filo Firmicutes entre doentes. Do mesmo modo, redução de Akkermansia e Ruminoccocus, previamente relacionados à doença psoriásica, não foram verificados. Talvez por baixa leitura em ambos os grupos. Por fim, não houve diferença naqueles indivíduos com história familiar de psoríase em parentes de primeiro grau, em termos de microbioma intestinal. Este trabalho é um dos poucos estudos brasileiros e traz novas evidências sobre microbioma e psoríase. Consideramos que o microbioma merece atenção, especialmente porque traz diferentes oportunidades de intervenção, embora ainda existam alguns pontos a serem confirmados com estudos prospectivos.(AU)

Background: Gut dysbiosis may play a role in immune-mediated diseases. There is a growing interest in understanding microbiome influence in psoriasis. Objectives: To study the gut microbiome in patients with severe psoriatic disease, when compared with individuals without psoriasis. In parallel, to evaluate the differences in the gut microbiome of individuals with psoriasis, with and without psoriatic arthritis. Finally, to evaluate the microbiome of individuals in the control group, differentiating them based on a positive family history of psoriasis in firstdegree relatives. Methods: V3/V4 16S rRNA gene sequencing and bioinformatic analyses were performed with the total DNA extracted from the stool samples of 30 patients with severe plaque psoriasis and 30 age and gender-matched controls from the same geographic location. The severity classification respected the consensus criteria, with those with an affected body surface area above 10% and/or a PASI score greater than 10 and/or a DLQI questionnaire also greater than 10; being considered severe disease. Results: Sixty individuals were studied. No difference in alpha-diversity was documented between the groups (p > 0.05). Beta-diversity analysis showed different clustering of the gut microbiome in severe psoriasis when compared with controls (p = 0.031). Firmicutes/Bacteriodetes ratio was higher psoriasis (p = 0.05). Adjusted differential abundance showed an increased expression of Sutterella gender (p < 0.01) and Sutterella wadsworthensis species (p < 0.05) in psoriasis group. When comparing patients with and without joint disease, it was not possible to document differences in terms of alpha or beta diversity. However, patients with established psoriatic arthritis showed higher expression of the Bacterioides genus (p = 0.02), and Bacteriodes uniform species (p = 0.03). No relevant difference was identified between controls when comparing individuals with and without a family history of psoriasis. Conclusions: It was possible to demonstrate a different pattern of gut microbiome among those with severe psoriatic disease, when compared to controls. There was a significant greater expression of the genus Sutterella and Sutterella wadsworthensis species among patients, which may represent a sign of dysbiosis related to psoriasis. In parallel, there were no statistically significant differences in alpha and beta diversity between patients with joint disease when compared to those without psoriatic arthritis. However, a hallmark in these patients was the greater expression of the genus Bacterioides and the species Bacteriodes uniformes. It is worth noting that the F/B ratio was lower in psoriatic patients. This is not an unprecedented finding, but contrary to most publications that demonstrates the predominance of the Firmicutes phylum among patients. Likewise, reduction of Akkermansia and Ruminoccocus, previously related to psoriatic disease, were not verified in our sample. Perhaps due to low reading in both groups. Finally, there was no difference in those individuals with a family history of psoriasis in first-degree relatives, in terms of gut microbiome. This paper is one of the few Brazilian studies and brings insights into microbiome and psoriasis. Microbiome deserves our attention, especially since it brings different opportunities for intervention, although there are still some key points to be confirmed with prospective studies.(AU)

Corneal topographic alterations in women with endometriosis: data analysis in an ophthalmologic clinic / Alterações topográficas corneanas em mulheres portadoras de endometriose: análise de dados em uma clínica oftalmológica

ABSTRACT Objective: To verify whether there are pathological dysfunctions in the cornea of patients with endometriosis. Methods: Case-control research with a quantitative approach that compared topographic and tomographic examinations of the cornea of patients with a laparoscopic diagnosis of endometriosis, without the use of hormonal medications, to the control group. Results: We analyzed 78 eyes, 34 from the endometriosis group and 44 from the control group. The loss of orthogonality between the axes of the corneal curvatures was more frequent in the group with endometriosis (p = 0.0744). The difference between the mean keratometric measurements of the two eyes was significantly greater in the control group (p = 0.0204). In the tomographic findings, the group with endometriosis presented higher means of posterior elevation compared to the control group (p = 0.0060). Conclusion: The results do not allow us to conclude that women with endometriosis have a higher risk of developing corneal ectasia, although the posterior elevation map demonstrated a greater posterior curvature of the cornea in this group, with a statistically significant difference. However, an isolated increase in the posterior elevation map does not have good diagnostic accuracy.

RESUMO Objetivo: Verificar se há disfunções patológicas na córnea de pacientes portadoras de endometriose. Métodos: Pesquisa do tipo caso-controle de abordagem quantitativa, que comparou exames topográficos e tomográficos da córnea de pacientes com diagnóstico laparoscópico de endometriose, sem uso de medicações hormonais, ao grupo controle. Resultados: Foram analisados 78 olhos, 34 do grupo com endometriose e 44 do grupo controle. A perda da ortogonalidade entre os eixos das curvaturas corneanas foi mais frequente no grupo com endometriose (p = 0,0744). A diferença entre as médias das medidas ceratométricas dos dois olhos foi significativamente maior no grupo controle (p = 0,0204). Nos achados tomográficos, o grupo com endometriose apresentou maiores médias de elevação posterior em relação ao controle (p = 0,0060). Conclusão: Os resultados não permitem concluir que portadoras de endometriose têm maior risco de desenvolver ectasia corneana, embora o mapa de elevação posterior tenha demonstrado maior curvatura posterior da córnea nesse grupo, com diferença estatisticamente significativa. Contudo, um aumento isolado no mapa de elevação posterior não possui boa acurácia diagnóstica.

Thromboembolic events in people with cancer during the COVID-19 pandemic: case-control study / Eventos tromboembólicos em pessoas com câncer na pandemia da COVID-19: estudo caso-controle / Eventos tromboembólicos en personas con cáncer durante la pandemia de COVID-19: estudio de caso-control

Abstract Objective: to analyze the association between coronavirus disease infection and thromboembolic events in people with cancer in the first year of the pandemic. Method: case-control study carried out by collecting medical records. The selected cases were adults with cancer, diagnosed with a thromboembolic event, treated in the selected service units during the first year of the pandemic. The control group included adults with cancer without a diagnosis of a thromboembolic event. Pearson's chi-square test was applied to verify the association between risk factors and the outcome and logistic regression techniques were applied to identify the odds ratio for the occurrence of a thromboembolic event. Results: there were 388 cases and 440 control cases included in the study (ratio 1/1). Females predominated, who were white, with mean age of 58.2 (±14.8) years. Antineoplastic chemotherapy was the most used treatment and coronavirus disease was identified in 11.59% of participants. In the case group, deep vein thrombosis was more prevalent. Conclusion: the study confirmed the hypothesis that coronavirus disease infection did not increase the chance of thromboembolic events in people with cancer. For the population studied, the factors that were associated with these events were those related to cancer and its treatment.

Resumo Objetivo: analisar a associação entre a infecção por coronavírus e os eventos tromboembólicos em pessoas com câncer, durante o primeiro ano da pandemia. Método: estudo caso-controle realizado mediante coleta em prontuários. Os casos estudados foram de adultos com câncer, com diagnóstico de evento tromboembólico, atendidos nas unidades do serviço selecionado durante o primeiro ano da pandemia. O grupo controle contou com adultos com câncer sem diagnóstico de evento tromboembólico. Teste qui-quadrado de Pearson foi aplicado para verificar associação entre fatores de risco e o desfecho de técnicas de regressão logística foram aplicadas para identificar a razão de chance de ocorrência de evento tromboembólico. Resultados: 388 casos e 440 controles foram incluídos no estudo (proporção 1/1). Prevaleceu o sexo feminino, raça branca, média de idade de 58,2 (±14,8) anos. A quimioterapia antineoplásica foi o tratamento mais utilizado e a doença por coronavírus foi identificada em 11,59% dos participantes. No grupo caso, trombose venosa profunda foi mais prevalente. Conclusão: o estudo confirmou a hipótese de que a infecção por doença por coronavírus não aumentou a chance de eventos tromboembólicos em pessoas com câncer. Para a população estudada, os fatores que tiveram associação com os eventos foram os relacionados ao câncer e seu tratamento.

Resumen Objetivo: analizar la asociación entre la infección por enfermedad por coronavirus y eventos tromboembólicos en personas con cáncer durante el primer año de la pandemia. Método: estudio caso-control realizado mediante la recolección de datos en historiales médicos. Los casos fueron adultos con cáncer, diagnosticados con evento tromboembólico, atendidos en las unidades del servicio seleccionado durante el primer año de la pandemia. El grupo control estuvo compuesto por adultos con cáncer sin diagnóstico de evento tromboembólico. Se aplicó la prueba de chi-cuadrado de Pearson para verificar la asociación entre factores de riesgo y el resultado, y se utilizaron técnicas de regresión logística para identificar la razón de posibilidades de ocurrencia de evento tromboembólico. Resultados: se incluyeron en el estudio 388 casos y 440 controles (proporción 1/1). Prevaleció el género femenino, raza blanca, con una edad media de 58,2 (±14,8) años. La quimioterapia antineoplásica fue el tratamiento más utilizado y la enfermedad por coronavirus fue identificada en el 11,59% de los participantes. En el grupo de casos, la trombosis venosa profunda fue más prevalente. Conclusión: el estudio confirmó la hipótesis de que la infección por enfermedad por coronavirus no aumentó la probabilidad de eventos tromboembólicos en personas con cáncer. Para la población estudiada, los factores que tuvieron asociación con estos eventos fueron los relacionados con el cáncer y su tratamiento.

Central line-associated bloodstream infections in patients with COVID-19 / Infecciones de la circulación sanguínea relacionadas con catéter venoso central en pacientes con COVID-19 / Infecção primária de corrente sanguínea relacionada a cateter venoso central em pacientes com COVID-19

Objective: to investigate the association between central line-associated bloodstream infections and clinical and care variables of intensive care unit patients with COVID-19 hospitalized at a reference public health institution. Method: a case-control study. Results: the study sample consisted of 70 patients diagnosed with central line-associated bloodstream infections (case group) and 70 non-infected patients (control group). Most patients were male, with mean age of 57.93±13.93 years old and provided with a double lumen catheter. Median time of central line-associated bloodstream infections onset was 11 (8-18) days. Longer time on mechanical ventilation ( P =0.014; OR: 1.79; 95% CI: 0.91-3.51) and prone position ( P =0.017; OR: 2.41; 95% CI: 1.22-4.81) were associated with central line-associated bloodstream infections onset. Conclusion: longer time on invasive mechanical ventilation and prone position contributed to central line-associated bloodstream infections onset in COVID-19 patients.

Objetivo: investigar la asociación entre infecciones de la circulación sanguínea relacionadas con catéter venoso central y variables clínicas y asistenciales de pacientes con COVID-19 ingresados en la unidad de cuidados intensivos de una institución pública de salud de referencia. Método: un estudio caso-control. Resultados: la muestra del estudio estuvo compuesta por 70 pacientes con diagnóstico de infección de la circulación sanguínea relacionada con catéter venoso central (grupo caso) y 70 pacientes no infectados (grupo control). La mayoría de los pacientes eran del sexo masculino, con edad media de 57,93±13,93 años y provistos de catéter de doble luz. El tiempo medio de aparición de las infecciones del torrente sanguíneo asociadas a catéter venoso central fue de 11 (8-18) días. Un mayor tiempo en ventilación mecánica ( P =0,014; RP: 1,79; IC 95%: 0,91-3,51) y en posición de decúbito prono ( P =0,017; RP: 2,41; IC del 95 %: 1,22-4,81) se asociaron con la aparición de infecciones de la circulación sanguínea relacionadas con catéter venoso central. Conclusión: un tiempo más prolongado con ventilación mecánica invasiva y posición de decúbito prono contribuyeron a la aparición de infecciones de la circulación sanguínea relacionadas con catéter venoso central en pacientes con COVID-19.

Objetivo: investigar a associação entre infecção primária de corrente sanguínea relacionada a cateter venoso central e variáveis clínicas e assistenciais de pacientes com COVID-19 internados na unidade de terapia intensiva de uma instituição pública de saúde de referência. Método: estudo caso-controle. Resultados: o estudo foi composto por 70 pacientes com diagnóstico de infecção primária de corrente sanguínea relacionada a cateter venoso central (grupo caso) e 70 pacientes sem infecção (grupo controle). Pacientes predominantemente do sexo masculino, média de idade de 57,93±13,93 anos e portadores de cateter de duplo lúmen. A mediana de tempo de ocorrência das infecções primárias de corrente sanguínea relacionadas a cateter venoso central foi de 11 (8-18) dias. Maior tempo em ventilação mecânica ( P =0,014; RP: 1,79; IC 95%: 0,91-3,51) e posição prona ( P =0,017; RP: 2,41; IC 95%: 1,22-4,81) foram associados à ocorrência de infecções primárias de corrente sanguínea relacionadas a cateter venoso central. Conclusão: maior tempo em ventilação mecânica invasiva e posição prona contribuíram para a ocorrência de infecções primárias de corrente sanguínea relacionadas a cateter venoso central em pacientes com COVID-19.

Evaluación del efecto sobre la estadía hospitalaria a propósito del cambio de tratamiento antibiótico intravenoso a vía oral en pacientes pediátricos apendicectomizados por apendicitis precoz en el Centro Hospitalario Pereira Rossell, 2020/2021 / Evaluation of the effect on hospital stay in cases of moving from intravenous to oral antibiotic treatment in pediatric patients after appendicectomy for early appendicitis at the Pereira Rossell Pediatric Hospital 2020/2021 / Avaliação do efeito na permanência hospitalar em casos de mudança do tratamento antibiótico intravenoso para oral em pacientes pediátricos apendicectomizados por apendicite precoce no Centro Hospitalar Pereira Rossell, 2020/2021

Objetivos: evaluar el efecto sobre el tiempo de estadía a propósito del cambio de modelo de tratamiento antibiótico en pacientes pediátricos cursando posoperatorio por apendicectomía precoz en el Centro Hospitalario Pereira Rossell (CHPR). Metodología: se realizó un estudio cuasi experimental con grupo de control histórico. La población objetivo estuvo compuesta por niños, niñas y adolescentes cursando posoperatorio por apendicectomía precoz en el Servicio de Cirugía Pediátrica. Resultados: se constató una diferencia estadísticamente significativa en el tiempo de internación poscirugía entre ambos grupos, diferencia que con una confianza de 95% podría ser por lo menos de 14 horas y como máximo de 33 horas. La magnitud del efecto en el tiempo de internación del grupo que recibió antibiótico vía oral luego de la apendicectomía, respecto de los que recibieron antibiótico por vía intravenosa, fue grande. Conclusiones: la nueva modalidad de tratamiento implementada para el posoperatorio de apendicitis aguda precoz (edematosas y flemonosas) por vía oral se asoció con una menor estancia hospitalaria. Esto conlleva, según los antecedentes existentes, a un menor riesgo de infecciones intrahospitalarias, una menor disrupción del entorno familiar del niño y a un uso más eficiente del recurso cama.

Objetives: assess the effect of hospital stay length when changing the antibiotic treatment model in pediatric patients undergoing postoperative early appendectomy at the Pereira Rossell Hospital. Methodology: a quasi-experimental study was carried out, with a historical control group. The target population was integrated by boys, girls and adolescents, undergoing postoperative early appendectomy in the Pediatric Surgical Ward. Results: a statistically significant difference was found in the post-surgery hospitalization time in both groups, a difference that with 95% confidence could be at least 14 hours and at the most 33. The significance of the effect on the hospitalization time of the group that received oral antibiotics after appendectomy, compared to those who received intravenous antibiotics was large. Conclusions: the new oral treatment modality implemented for the postoperative period of early acute appendicitis (edematous and phlegmonous) was linked to a shorter hospital stay. This leads, according to existing precedents, to a lower risk of in-hospital infections, less disruption of the child's family environment and a more efficient use of bed resources.

Objetivos: avaliar o efeito no tempo de internação da mudança no modelo de tratamento antibiótico em pacientes pediátricos submetidos à apendicectomia precoce pós-operatória no Hospital Pereira Rossell. Metodologia: foi realizado um estudo quase experimental, com o grupo de controle histórico. A população-alvo foi composta por meninos, meninas e adolescentes, submetidos ao pós-operatório de apendicectomia precoce no Serviço de Cirurgia Pediátrica. Resultados: foi encontrada diferença estatisticamente significativa no tempo de internação pós-cirúrgica em ambos os grupos, diferença que com 95% de confiança poderia ser de no mínimo 14 horas e no máximo 33. A magnitude do efeito no tempo de internação do grupo que recebeu via oral antibióticos após apendicectomia, em comparação com aqueles que receberam antibióticos intravenosos foi grande. Conclusões: a nova modalidade de tratamento oral implementada no pós-operatório de apendicite aguda precoce (edematosa e flegmonosa) esteve associada a menor tempo de internação. Isso leva, de acordo com os precedentes existentes, a um menor risco de infecções hospitalares, a uma menor perturbação do ambiente familiar da criança e a uma utilização mais eficiente do recurso cama.

Breastfeeding and autism spectrum disorder: case-control study / Transtorno do espectro do autismo e aleitamento materno: estudo de caso controle

Abstract Objectives: to evaluate the association between breastfeeding and Autism Spectrum Disorder (ASD) in children and adolescents. Methods: this is a case-control study carried out in the north of the state of Minas Gerais, Brazil, which included 248 children and adolescents diagnosed with ASD (case group) and 886 children and adolescents without a diagnosis of ASD (control group).Interviews were conducted with the mothers of children and adolescents and a semi-structured questionnaire was used to collect data. For data analysis, a multiple logistic regression model was adopted. The magnitude of associations was estimated by the odds ratio (OR). Three multiple models were fitted: Model 1: presence or absence of breastfeeding; Model 2: duration of breastfeeding; Model 3: duration of exclusive breastfeeding. Results: ASD was associated with the absence of breastfeeding in the three adjusted models: Model 1: OR=2.1, CI95%=1.1-4.1; Model 2: OR=2.3, CI95%=1.2-4.5; Model 3: OR=2.3, CI95%=1.2-4.5. Conclusions: individuals with ASD were more likely to have not received breastfeeding, however, due to the nature of case control studies, it cannot be stated that breastfeeding prevents ASD. Conducting a cohort study may clarify this relationship.

Resumo Objetivos: avaliar a associação entre aleitamento materno e Transtorno do Espectro do Autismo (TEA) em crianças e adolescentes. Métodos: trata-se de um estudo caso-controle realizado no norte de Minas Gerais, Brasil, que incluiu 248 crianças e adolescentes com diagnóstico de TEA (grupo caso) e 886 crianças e adolescentes sem diagnóstico de TEA (grupo controle). Foram realizadas entrevistas com as mães das crianças e adolescentes e utilizado um questionário semiestruturado para coleta dos dados. Para análise dos dados foi adotado modelo de regressão logística múltipla. A magnitude das associações foi estimada pela Odds Ratio (OR). Três modelos múltiplos foram ajustados: Modelo 1: presença ou ausência de aleitamento materno; Modelo 2: duração do aleitamento materno; Modelo 3: duração do aleitamento materno exclusivo. Resultados: o TEA foi associado à ausência de aleitamento materno nos três modelos ajustados: Modelo 1: OR=2,1, IC95%=1,1-4,1; Modelo 2: OR=2,3, IC95%=1,2-4,5; Modelo 3: OR=2,3, IC95%=1,2-4,5. Conclusões: os indivíduos com TEA tiveram maiores chances de não terem recebido aleitamento materno, no entanto, devido à natureza dos estudos de caso-controle, não se pode afirmar que o aleitamento materno previna o TEA. A realização de um estudo de coorte poderá esclarecer essa relação.

Evaluación de las Lesiones Orofaciales y Traumatismos Dentales en Deportes de Combate y no Combate / Evaluation of Orofacial Injuries and Dental Trauma in Combat and Non-Combat Sports

Los deportes de combate conllevan un alto riesgo de padecer traumatismos dentoalveolares. Este estudio se evaluó la incidencia de traumatismos y lesiones orofaciales relacionadas con los deportes de combate, junto con la evaluación de las actitudes y hábitos de los deportistas respecto al uso de protectores bucales. Este estudio se realizó mediante sistema de encuestas digitales distribuidas en diferentes clubes deportivos donde se practican deportes de combate y no combate. Los deportistas de combate tienen más probabilidad sufrir alguna lesión orofacial que los no deportistas de combate. El sexo masculino y la experiencia son factores predisponentes en la aparición de traumatismos y lesiones orofaciales, siendo las laceraciones de tejidos blandos las más frecuentes. Los deportistas de combate llevan más protectores bucales que los deportistas en general, siendo el protector tipo II el más usado. Los deportistas que no llevan protectores no consideran que sea necesario. En caso de sufrir una avulsión dental, la mayoría de los participantes consideran que es posible reimplantar un diente avulsionado.

Combat sports carry a high risk of suffering dentoalveolar trauma. This study evaluated the incidence of dentoalveolar lesions related to combat sports, together with the evaluation of athletes' attitudes and habits regarding the use of mouth guards. This study was carried out using a digital survey system distributed in different sports clubs where combat and non-combat sports are practiced. Combat athletes are more likely to suffer a dentoalveolar lesion than non-combat athletes. Male sex and experience are predisposing factors in the appearance of dentoalveolar lesions, with soft tissue lacerations being the most frequent. Combat athletes wear more mouth guards than athletes in general, with the type II protector being the most used. Athletes who do not wear protectors do not consider it necessary. In case of suffering a dental avulsion, most of the participants consider that it is possible to reimplant an avulsed tooth.

Desarrollo de la Psicomotricidad en Estudiantes de Odontología Durante el Confinamiento por COVID-19 / Assessment of Psychomotor Skills in Dental Students During the COVID-19 Lock-Out Period

Las habilidades psicomotrices son un pilar fundamental del aprendizaje en odontología y clásicamente han sido trabajadas a través de la simulación o atención de pacientes. Durante el confinamiento debido a COVID-19, los estudiantes no tuvieron factibilidad de realizar procedimientos preclínicos. Debido a esto, se implementaron sesiones de entrenamiento de habilidades psicomotrices, en formato online, que permitieran preparar a los estudiantes durante el confinamiento para el retor no a la clínica. Se implementaron sesiones de entrenamiento psicomotriz a través de la utilización de materiales de artes plástica s e instrumental odontológico en formato online y guiados por una Terapeuta ocupacional. Para su medición, se realizó un estudio de casos y controles, donde los grupos se seleccionaron por conveniencia entre estudiantes que participaron de las sesiones y aquellos que tuvieron la formación virtual tradicional. La experiencia se evaluó a través cuestionario de autopercepción contestado por los estudiantes con respuestas en una escala de Likert y se comparó a través de pruebas estadísticas no paramétricas. Se recolectó una muestra total de 27 estudiantes, con una edad promedio de 23,7 años. Al comparar las respuestas de ambos grupos, los estudiantes del grupo casos percibieron significativamente una mejor sujeción de objetos pequeños utilizando pinzas, manipulación de instrumentales manuales y rotatorios de manera más precisa y mejor coordinación entre ambas manos durante un procedimiento simple en boca en comparación al grupo que no participó de las mismas. El entrenamiento de habilidades psicomotrices realizadas durante el periodo de confinamiento mostró resultados positivos en la percepción de las habilidades psicomotrices de los estudiantes, siendo una estrategia de bajo costo para ser implementada durante la formación de destrezas de los estudiantes de odontología en diferentes contextos. Sin embargo, para una mejor implementación debe estar en conjunto a estrategias de simulación para ser totalmente efectiva.

Psychomotor skills are a fundamental pillar of learning in dentistry and traditionally have been worked on through simulation or patient care. During the confinement due to COVID-19, students were not able to perform preclinical procedures. Due this, psychomotor skills training sessions were implemented, in online format to prepare students during confinement for the return to the patient care. Psychomotor training sessions were implemented using plastic arts materials and dental instruments in online format and guided by an occupational therapist. For its measurement, a case-control study was carried out, where the groups were selected by convenience between students who participated in the sessions and those who had traditional virtual training. The experience was evaluated through a self- perception questionnaire answered by the students with answers on a Likert scale and compared through non- parametric statistical tests. A total sample of 27 students was collected, with an average age of 23.7 years. When comparing the responses between groups, the students in the case group perceived significantly better grasping of small objects using forceps, more precise manipulation of hand and rotary instruments and better coordination between both hands during a simple mouth procedure compared to the group that did not participate in the same. The psychomotor skills training performed during the confinement period showed positive results in the perception of psychomotor skills of the students, being a low-cost strategy to be implemented during the skills training of dental students in different contexts. However, for a better implementation it should be in conjunction with simulation strategies to be fully effective.